Improving health care delivery for older adults requires investigation by both trained geriatricians and subspecialists with a geriatric focus. Infections in older adults are a common public health problem that lead to functional decline, mortality, and healthcare expenditures. Nursing home residents, in particular, are a vulnerable population in whom further investigation is warranted to optimize medical care. Urinary tract infection (UTI) in nursing home residents is an investigatively understudied topic. The primary objective of this application is to train Dr. Juthani-Mehta, the candidate, to be an investigative leader in geriatric infectious diseases and to advance multidisciplanary research in UTI in nursing home residents. The goals of this career development plan are: 1) to establish the candidate as a patient-oriented investigator at the interface of infectious diseases, geriatric medicine, and nursing home practice;2) to gain additional training and mentorship in chronic disease epidemiology, infectious diseases epidemiology, and longitudinal study design;3) to obtain skills in clinical trial design, geriatric medicine, and infection control methodology in nursing homes;and 4) to prepare the candidate to conduct multi-center observational and interventional clinical trials in long-term care facilities. The specific aims of the research plan are: 1) to determine the reliability of urinary tract specific (e.g. flank pain or tenderness) and urinary tract non-specific (e.g., change in mental status) clinical features as assessed by nursing home staff in nursing home residents with suspected UTI;and 2) to identify and validate those reliable clinical features in residents with suspected UTI that are associated with laboratory evidence of UTI (i.e., bacteriuria plus pyuria). Supplementary aims are to identify residents with suspected UTI that have adverse outcomes related to UTI, to treatment, or to either. The combination of reliable and validated clinical features, bacteriuria, and pyuria will be the basis for an evidence-based definition of UTI. The candidate is an emerging patient-oriented investigator with unique training in infectious diseases and geriatric clinical epidemiology. Since she has been recognized nationally by the Infectious Diseases Society of America as a Williams Scholar, she is an ideal candidate to be an investigative leader in this field. The renowned mentors she has assembled and the environment at Yale University will allow for outstanding training and the successful completion of the proposed study.